维奈克拉联合阿扎胞苷治疗初诊不适合强化疗的急性髓系白血病患者的疗效观察  

Efficacy of venetoclax combined with azacitidine in the treatment of patients with newly diagnosed unfit acute myeloid leukemia

作　　者：韦梦红 夏海龙[1] WEI Menghong;XIA Haiong(Department of Hematology,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,Anhui,China)

机构地区：[1]安徽医科大学第一附属医院血液科,安徽合肥230000

出　　处：《中国现代医生》2024年第1期74-77,共4页China Modern Doctor

摘　　要：目的 观察VA方案(维奈克拉+阿扎胞苷)治疗初诊不适合强化疗的急性髓系白血病(acute myeloid leukemia,AML)患者的疗效及安全性。方法 回顾性分析2021年4月至2023年2月于安徽医科大学第一附属医院接受VA方案治疗的初治不适合强化疗的AML患者55例,评估该方案的治疗疗效及安全性。结果 AML患者中位治疗疗程3(1~10)个,第一疗程结束后完全缓解(complete response,CR)/完全缓解伴血液学未完全恢复(CR with incomplete blood count recovery,CRi)率为78.2%,微小残留(minimal residual,MRD)转阴率61.8%;CR/CRi率和MRD转阴率均随着疗程增加而逐渐增加,有IDH1/IDH2、NPM1、ASXL1突变及无TP53突变的患者对VA方案的治疗反应较好。中位随访时间9.1(1.2~24.0)个月,生存39例,死亡16例,中位总生存(overall survival,OS)时间17.4个月,CR/CRi患者的OS时间显著长于部分缓解或未缓解患者(P<0.001)。几乎所有患者都出现不同程度的贫血、血小板减少和白细胞减少;在非血液学不良事件方面,感染最为常见。结论 VA方案在初诊不适合强化疗的AML患者中获得较高的治疗反应率,部分缓解患者可快速获得MRD转阴。IDH1/IDH2、ASXL1、NPM1、TP53突变可能是影响患者疗效的预测因素。Objective To observe the efficacy and safety of VA regimen(venetoclax+azacitidine)in the treatment of patients with newly diagnosed unfit acute myeloid leukemia(AML).Methods From April 2021 to February 2023,55 unfit AML patients who were treated with VA regimen in the First Affiliated Hospital of Anhui Medical University were retrospectively analysed.The therapeutic efficacy and safety of VA regimen were evaluated.Results The median treatment courses of AML patients was 3(1-10),and complete response(CR)/CR with incomplete blood count recovery(CRi)rate was 78.2%and minimal residual(MRD)negative conversion rate was 61.8%after the first treatment course.CR/CRi rate and MRD negative conversion rate increased gradually with the increase of treatment course.Patients with IDH1/IDH2,NPM1,ASXL1 mutations and without TP53 mutations responded well to the VA regimen.The median follow-up time was 9.1(1.2-24.0)months.39 patients survived and 16 patients died.The median overall survival(OS)was 17.4 months.Patients with CR/CRi had significantly longer OS duration than patients with partial response or non-response(P<0.001).Almost all patients had different degrees of anemia,thrombocytopenia,leukopenia.In terms of non-hematological adverse events,infection was the most common.Conclusion The VA regimen achieved a higher treatment response rate in newly diagnosed unfit AML patients,and partial response patients could quickly obtain negative MRD.IDH1/IDH2,ASXL1,NPM1,TP53 mutations may be the predictors of patient outcomes.

关 键 词：维奈克拉 阿扎胞苷 急性髓系白血病 总生存 不良事件 

分 类 号：R733.7[医药卫生—肿瘤]